Objective To explore the feasibility and clinical outcome of lateral cervical incision via sternocleidomastoid intermuscular approach(SMIA)in the treatment of primary hyperparathyroidism.Methods The clinical data of 64 patients with primary hyperparathyroidism who underwent unilateral parathyroid surgery in the First Affiliated Hospital,School of Medicine of Zhejiang University from January 2019 to June 2022 were retrospectively analyzed.They were divided into lateral cervical incision via sternocleidomastoid intermuscular approach group(SMIA group)and linea alba cervicalis approach group(LACA group)based on the surgical incision and access route.The differences in clinical features,surgery-related outcomes and postoperative functions of the anterior cervical region were compared between the two groups.The EQ-5D-5L scale was used to assess the subjective feeling of postoperative neck discomfort,while the Hollander Wound Assessment Scale was used to assess the clinical outcome of incision healing.Results There were no statistical differences between the two groups of patients in terms of age,gender,intraoperative bleeding,parathyroid hormone or blood calcium levels before and after surgery(P＞0.05).The duration of surgery was significantly shorter in the SMIA group than in the LACA group[(39.77±5.69)min vs.(54.41±4.66)min].There was a statistical difference between the two groups in functional protection of the anterior cervical region at 1 month and 12 months after surgery(1 month,84.67±3.74 vs.79.47±5.38,P＜0.001;12 months,93.80±2.52 vs.89.94±2.39,P＜0.001),and the SMIA group was better than the LACA group.The Hollander Incision Assessment Scale scores of the SMIA group were better than those of the LACA group at 6 months and 12 months after surgery,and the difference was statistically significant(6 months,1.93±0.58 vs.2.41±0.66,P=0.003;12 months,1.03±0.67 vs.1.74±0.62,P＜0.001).Conclusion Parathyroidectomy via sternocleidomastoid intermuscular approach through lateral cervical incision is a simple,safe and effective surgical procedure,which makes it easier to search for parathyroid lesions and shortens the surgical time compared with the traditional incision,and has obvious advantages in the protection of anterior cervical region function.

Radical cystectomy combined with pelvic lymph node dissection is the standard procedure for the treatment of muscle invasive bladder cancer and complex non-muscle invasive bladder cancer.Our department has routinely carried out laparoscopic radical cystectomy(ELRC)through the extraperitoneal approach in 340 cases.This article summarizes the establishment of the peritoneal space,the expansion of the peritoneal space,the operation steps of bladder resection and lymph node dissection through the peritoneal channel,and how to shorten the operation time and reduce the difficulty of the operation.During the surgery,the bladder is removed periperitoneally without destroying the peritoneum to preserve the functions of peritoneum support,secretion,protection and lubrication,which has little impact on the abdominal organs,reduces the incidence of complications,and provides favorable conditions for subsequent treatment.

【Objective】 To explore the safety and efficacy of a modified one-piece posterior laparoscopic total nephroureterectomy with cystic sleeve resection in the treatment of upper urinary tract uroepithelial carcinoma (UTUC). 【Methods】 A total of 24 patients treated during Jan. and Jun. 2022 were involved, including 16 males and 8 females, aged 62 to 90 (average 73) years. The UTUC was in the left side in 15 cases, and in the right side in 9 cases. There were 10 cases of renal pelvis tumor, 6 cases of upper ureteral tumor and 8 cases of lower ureteral tumor. 【Results】 All operations were successful without conversion to open surgery. The operation time ranged from 60 to 100 minutes, average (71.25±9.80) minutes. The intraoperative bleeding volume was 20 to 200 mL, average (30.03±8.13) mL. No significant intraoperative or postoperative complications occurred. The postoperative hospital stay was 4 to 7 days, average (5.83±1.44) days. Bladder perfusion chemotherapy was performed after surgery. 【Conclusion】 The modified one-piece posterior laparoscopic total nephroureterectomy plus cystic sleeve resection for UTUC is an effective and feasible procedure with satisfactory tumor control, which is worth further promotion in clinical practice.

【Objective】 To investigate the efficacy and safety of single position transabdominal and extraperitoneal laparoscopic radical nephroureterectomy in the treatment of upper tract urothelial carcinoma (UTUC). 【Methods】 Clinical data of 31 UTUC cases treated in our hospital during Nov.2018 and Jun.2022 were retrospectively analyzed, including 11 tumors in the right side, and 20 in left side. There were 14 cases of renal pelvic carcinoma, 16 cases of ureter carcinoma, and 1 case of renal pelvic carcinoma plus ureter carcinoma. 【Results】 All surgeries were successfully performed without conversion to open surgery. The mean operation time was (81.45±19.80) min, and the estimated blood loss was (69.03±24.13) mL. No serious perioperative complications were observed. The average postoperative hospital stay was (6.13±2.44) d, and the median follow-up was 28 (3.0-49.0) months. At the last follow-up, 2 patients died, 3 had recurrence, but no contralateral recurrence was observed. 【Conclusion】 Single position transabdominal and extraperitoneal laparoscopic radical nephroureterectomy is safe, effective and feasible in the treatment of UTUC. It is worth clinical popularization.

Objective    To study the feasibility and safety of CT-guided preoperative Hookwire localization of pulmonary nodules in clinical application. Methods    Clinical data of 102 patients who were scheduled to undergo surgical treatment for pulmonary nodules from June 2015 to April 2020 in the North Ward of Thoracic Surgery Department of Ruijin Hospital were retrospectively analyzed. There were 38 males and 64 females, aged 23-82 (53.2±12.8) years. Results    All 102 patients with pulmonary nodules underwent CT-guided preoperative Hookwire localization successfully, with a localization success rate of 100.0%. The localization time was 27.0 (11-67) min; the number of times to adjust the angle during the positioning process was 6.9 (3-14); the needle depth of the positioning needle was 41.5 (16.3-69.1) mm. A total of 48 (47.1%) patients had a small amount of bleeding in the lung tissue in the positioning area after positioning; 53 (51.9%) patients had a small amount of pneumothorax after positioning; 16 (15.7%) patients were found that the positioning needle completely shedded from the lung tissue in the subsequent surgery. One patient was transferred to open thoracotomy because of extensive dense adhesion in the thorax, and the remaining 101 patients were operated on under thoracoscopy. Postoperative pathology showed that 5 (4.9%) patients were adenocarcinoma in situ, 28 (27.5%) were microinvasive adenocarcinoma, 36 (35.3%) patients were invasive carcinoma and 32 (31.3%) patients were benign lesions. No patients had complications or adverse events related to preoperative positioning. Conclusion    Pre-operative CT-guided localization of Hookwire intrapulmonary nodules is safe and effective, and can meet the intraoperative localization needs of thoracic surgeons in most clinical situations, and is not inferior to other preoperative localization methods currently used in clinics.

Objective:To observe the association between serum cystatin C(CysC)and bone turnover markers levels in elderly chronic kidney disease(CKD)patients with different estimated glomerular filtration rate(eGFR).Methods:A total of 74 elderly patients aged 61-97(79.5±8.7)years with 40 males, receiving serum CysC and bone turnover markers tests, were recruited in the Department of Geriatrics, Peking University Third Hospital from June 2019 to June 2020.They were divided into normal eGFR group(G1 and G2 stage)(eGFR≥60 ml·min -1·1.73 m -2, n=42)and decreased eGFR group(G3-G5 stage)(eGFR<60 ml·min -1·1.73 m -2, n=32). Serum levels of CysC and bone turnover markers[β-isomerized C-terminal telopeptides(β-CTX)and procollagen type I N-terminal propeptide(P1NP)]were tested.The association between CysC and bone turnover markers was analyzed. Results:The levels of β-CTX, P1NP and parathyroid hormone(PTH)were higher in decreased eGFR group(G3-G5 stage)than in normal eGFR group(G1 and G2 stage), and 25(OH)D3 was lower in decreased eGFR group(G3-G5 stage)than in normal eGFR group(G1 and G2 stage), but the differences were not statistically significant(all P>0.05). In decreased eGFR group(G3-G5 stage), CysC had significant association with β-CTX( r=0.598, P<0.01)and P1NP( r=0.519, P<0.01), respectively.In normal eGFR group(G1 and G2 stage), CysC was significantly related with P1NP( r=0.342, P<0.05), and CysC had no correlation with β-CTX( r=-0.030, P> 0.05). Multiple regression analysis showed that CysC was independently positively associated with P1NP in total 74 subjects( β=19.19, P<0.01), and in 21 osteoporosis patients( β=28.78, P<0.05). Conclusions:In elderly patients with moderate and severe renal dysfunction, a higher CysC level indicates higher bone turnovers.CysC is independently positively associated with the bone formation marker P1NP, suggesting CysC may reflect a bone protective effect in elderly patients with different renal function.

【Objective】 To investigate the expression of BMP8A in papillary thyroid carcinoma (PTC) and the relationship between its expression level and clinicopathological features of PTC patients. 【Methods】 Based on TCGA and GEO databases, we analyzed and screened BMP8A, one differentially expressed gene related to PTC. From April 2019 to October 2019, 35 cases of thyroid papillary carcinoma and the tumor-adjacent tissues were collected from the Department of Gastrointestinal Gland Surgery, the First Affiliated Hospital of Guangxi Medical University. Real-time PCR was used to detect the expression of BMP8A in PTC and tumor-adjacent tissues, and the relationship between different expression levels and clinicopathological features of the patients was analyzed and compared. Then, we used Western blotting for verification. 【Results】 Both Real-time PCR and Western blotting analyses proved that the expression of BMP8A in PTC was significantly lower than that in the tumor-adjacent tissues (P<0.05), and the expression of BMP8A was also significantly decreased in PTC tissues with cervical lymph node metastasis compared with those without metastasis(P<0.05). 【Conclusion】 BMP8A has a low expression in papillary thyroid carcinoma, and its expression level is related to cervical lymph node metastasis. BMP8A may be a suppressor gene of PTC. This may provide a new direction for further exploring the mechanism of cervical lymph node metastasis in PTC and preventing recurrence after surgery.

Primary acinic cell carcinoma (ACC) of the lung is extremely rare. The World Health Organization tumor classification defines ACC as "a malignant epithelial neoplasm that demonstrates some cytological differentiation towards (serous) acinar cells". It is considered to be a low-grade malignant tumor. Since the first case described by Fechner in 1972, less than 30 cases have been reported in the literature. The rarity of this tumor may leads it to be confused with other primary lung tumors and incorrectly diagnosed. We reported a female patient with primary ACC of the lung with mediastinum deviation at age of 27 years received a right pneumonectomy. She was followed up for 12 months postoperatively and remains well.

Objective: To determine the clinical application value of percutaneous lung biopsy guided by ultrasound in the diagnosis of peripheral lung lesions of silicosis. Methods: Experimental silicosis was produced in rabbits by the intratracheal administration of silica with non-exposure method. Imaging changes were observed in 36 rabbits on 60 days after intratracheal instillation of silica. To contrast with CT results, percutaneous lung biopsy of peripheral lesions was guided by ultrasound. The success rate of sufficient material, the diagnosis rate of coincidence between biopsy and pathology, and the incidence of complications were calculated. The biopsy with sufficient material, biopsy findings coincided with pathological results and no complications were defined as strictly success of the puncture. The baseline data and monitoring index were compared between successful biopsy group and unsuccessful biopsy group. Each rabbit was intravenously administrated by 10 000 U of heparin for the antiocoagulation and sacrificed by fast injection of 10% KCl through jugular vein catheterization. Specimens from lung tissue were collected and stained with hematoxylin-eosin. Pathological changes of lung tissue were observed through an optical microscope. Results: Of 36 silicosis rabbits, peripheral lung lesions of silicosis were observed in 30 rabbits. Biopsy procedures were performed with ultrasound guidance in 30 rabbits. The total success rate of biopsy was 70% (21/30). The success rate of sufficient material was 93% (28/30), the diagnosis rate of coincidence between biopsy and pathology 86%(24/28), and the incidence of complications was 10% (3/30) respectively. Compared with failure group, peripheral lesions in successful biopsy group were bigger in size, closer to the chest wall, and lower respiratory rate, the difference was statistically significant (P<0.05). There was no significant difference in weight, heart rate, temperature and stages of silicosis (P>0.05). The pathological results showed typical silicosis nodules. Silica-exposed rabbit also showed signs of vascular remodeling with pulmonary artery muscularization, vascular occlusion, and medial thickening. Conclusions Ultrasound-guided percutaneous lung biopsy is an effective and safe method in peripheral lung lesions of silicosis. It can serve as an important technical means to monitor the evolution of silicosis lesions and provide reference for the diagnosis of silicosis. Observation of small vascular changes in silicosis nodules by lung biopsy is helpful for clinical intervention treatment.

Objective To explore the effects of alanyl-glutamine (Ala-Gln) dipeptide supplemented parenteral nutrition (PN) on the short-term outcomes in critically ill adult patients.Methods In this retrospective study,we reviewed the clinical data of critically ill adult patients who were treated by standard PN from January 2006 to December 2011.The length of stay in intensive care unit (ICU-LOS),incidences of infections and multiple organ dysfunction syndrome (MODS),and mortality were compared between the group of Ala-Gln dipeptide supplemented PN (intervention group) and the group of PN without Ala-Gln dipeptide (control group).Results Finially,617 cases were enrolled in the study,including 312 cases in the control group and 305 cases in the intervention group.The ICU-LOS was significantly shorter in the intervention group than that in the control group [(17.2 ± 6.5) d vs.(16.1 ± 5.3) d,P =0.011).Compared with the control group,the incidences of infection (42.9％ vs.33.1％,P =0.011) and MODS (46.5％ vs.38.0％,P =0.030) and the mortality (34.9％vs.25.9％,P =0.014) in the intervention group patients were significantly lower.Conclusion Ala-Gln dipeptide supplemented PN can improve the short-term outcomes of critically ill adult patients.